Feet, know thy pain

Some common injuries can easily sideline amateur athletes as well as professionals

January 19, 2007|By Jeannine Stein | Jeannine Stein,Los Angeles Times

From the pickup basketball player to the motivated marathoner, all who exercise can suffer the agony of the feet. Here are the most common injuries:

Plantar fasciitis

Any activity that involves jumping, plus sudden stops and starts, can lead to plantar fasciitis. This overstretching of the ligament that runs from the heel to the ball of the foot, straight through the arch, affects about 14 percent of men and women ages 18 to 60, according to the American Podiatric Medical Association.

Cause --The repeated stress of propelling the foot upward strains the ligament, sometimes creating small tears and possibly also causing pain at the arch and in the heel. Being overweight can exacerbate the condition.

Treatment --First, try rest, plus orthotics that lift the arch and take the pressure off the ligament. If that doesn't do it, try a leg splint worn at night to keep the foot at a 90-degree angle, so the plantar fascia is prevented from tightening up. For those prone to plantar fasciitis, physical therapists often recommend exercises to stretch the ligament.

Achilles tendinitis

The tendon that brought down the mythic hero Achilles also fells runners, dancers and gymnasts.

Cause --The Achilles tendon connects the calf muscle to the back of the heel bone. It's the action of the foot that can cause injury -- specifically too much bounding, jumping or fast-paced running. All that stress can eventually lead to inflammation, strains and micro-tears in the tendon, forming scar tissue that results in inflexibility. That can cause severe pain that shoots like a thunderbolt from the back of the ankle with every step. In extreme cases, the Achilles can completely rupture.

Prevention --Do stretching exercises, three times a day when warmed up, to increase the tendon's flexibility.

Treatment --Shoes that offer a slight heel raise (about 1 1/2 inches) can take stress off the tendon while it heals. Ultrasound can help break up scar tissue, as can massage therapy. Low-level laser treatments are being tested.

Neuromas

The front of the foot has its own sports-related problems. Neuromas are nerves that are squeezed between tissue and metatarsal bones, those long bones behind the toes. They're especially common among cyclists, whose forefeet are under constant pressure.

Victims usually feel pain on the ball of the foot, between the third and fourth metatarsal bones, behind the toes.

Cause --The nerve has an extra branch, making it more likely to be pinched, and some feet have metatarsal bones that are naturally closer together, leaving less space for the nerve.

Prevention --The first line of defense is simple: change shoes. If they're on the worn side, opt for ones with more cushioning. If your forefoot is squeezed, try another brand with a wider toe box. Orthotics may help, too.

Treatment --Cortisone shots can shrink the nerve and reduce pain. Some doctors inject an alcohol solution into the foot to kill the nerve. Surgery, used in a few cases, removes the nerve, usually causing no serious side effects.

Capsulitis

Basketball and tennis players -- and those with unusually high arches -- know the feeling well: a bruised sensation in the ball of the foot that can bring pain with every step.

Known as capsulitis and caused by inflammation around the joint capsule, the condition usually occurs under the second or third metatarsal bone. MRIs are helpful in detecting these injuries, which usually can't be seen on X-rays.

Cause --Pounding on a hard surface. Wearing hard-soled shoes can intensify the condition.

Prevention --Choose well-padded athletic shoes. Another option is to wear two pairs of socks for more padding.

Treatment --Cortisone shots can reduce inflammation, and orthotics can help redistribute the body's weight more evenly.

Stress fractures

For these micro-cracks within the bone, a casual walker can be as much at risk as an ultra-marathoner -- if both are overdoing activity and overtaxing the feet.

Excessive running, stair-climbing or other cardio activity can leave the bone unable to adapt and repair quickly enough by building up more calcium and becoming stronger. Pain intensifies over several days, he says.

Cause --The metatarsal bones are the most common site of stress fractures, because they bear much of the body's weight. The heel bone is another hot spot.

Prevention --Increase activities gradually.

Treatment --Rest alone usually doesn't fix the problem, because even a minimal amount of walking can put stress on the foot. Often, the foot is immobilized in a cast for several weeks.